Improving Care for Patients With Disabilities

An estimated 40.7 million noninstitutionalized Americans live with a disability — most commonly with an ambulatory, cognitive or independent living difficulty.¹ Ensuring access to oral health care for this population is a challenge. Patients with disabilities may require more time, adaptive equipment and anesthesia that private dental plans and government insurance programs may not cover. In addition, dentists may feel unprepared to care for these patients due to lack of training. In a survey of 500 Michigan dentists, general practitioners were least likely to accept adult patients with autism, and pediatric dentists were least likely to accept patients with closed head injuries. In contrast, providers with greater training were more likely to treat patients with special needs.²

Compared to those who are not disabled, surveys have shown individuals with disabilities are more likely not to have undergone an oral prophylaxis in the past five years, and to have higher rates of edentulism.³ To help address these disparities, in 2018 the American Dental Association revised its Principles of Ethics and Codes of Professional Conduct to state that disability should not be grounds for patient refusal. In addition, last year the Council on Dental Accreditation required dental schools to provide education in treating patients with intellectual and developmental disabilities. This includes training in predoctoral programs, orthodontics programs, dental hygiene programs and dental assistant programs.

It will be important to monitor if these changes improve access to care, especially for patients with autism, cerebral palsy, neurological disorders or closed head injuries — conditions that correlate with some of the lowest rates of acceptance in the Michigan survey. Another development worth watching is whether mandatory training in schools also improves access to continuing education for practicing professionals.

Beyond these efforts, changes in dental reimbursement models may ultimately be needed to improve access and treatment for patients with disabilities.

REFERENCES

1. U.S. Census Bureau. 2017 American Community Survey 1-Year Estimates. Available at: https://factfinder. census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_15_1YR_S1810&prodType=table. Accessed January 17, 2020.
2. Dao LP, Zwetchkenbaum S, Inglehart MR. General dentists and special needs patients: Does dental education matter? J Dent Educ. 2005;69:1107–1115.
3. Armour BS, Swanson M, Waldman HB, Perlman SP. A profile of state-level differences in the oral health of people with and without disabilities, in the U.S., in 2004. Public Health Rep. 2008;123:67–75.

From Decisions in Dentistry. February 2020;6(2):46.